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Effortlessness as the Unlikely Medicine for Pelvic Floor Pain

In an earlier podcast I discussed ‘letting go’ as the medicine of the Wise-Anderson Protocol. By letting go, I mean the release of muscle tension inside and outside the body and daily reduction of nervous arousal enabling the healing of sore pelvic tissue. By letting go I mean ceasing to hold the sore, irritated pelvic tissue captive in the reflex tightening that the pelvic floor does when it feels pain or intrusion.

The methods we use to help patients let go of a painful, contracted pelvic floor in the Wise-Anderson Protocol are both physical and mental/behavioral. The physical way we help patients learn to relax is by self-treatment doing myofascial release and trigger point release using our internal and external trigger point release devices. The physical release of chronically sore and tightened tissue using these methods is essential in helping someone to reach a level of relaxation and ease of the pelvic floor that relaxation alone cannot reach. When muscles have shortened and trigger points form, the muscle can only loosen to a certain point, just like a rubber band cannot extend to its full length if there is a knot tied in it.

In a daily protocol, after the tissue is repetitively loosened physical, a specific relaxation method, when done skillfully and in conjunction with the physical self-treatment, can help the pelvic pain patient reach areas of profound relaxation that are not able to be reached otherwise. This profound relaxation is what I think of as a healing chamber for the sore and irritated tissue of the pelvic floor.

Learning to let go, is the practice of being effortless. One of the central instruction of my relaxation teacher, Dr. Edmund Jacobson, was to discontinue effort.  Babies are the best at being effortless and do not need any training to help them relax. In fact no one needs to learn how to relax.  The ability to relax is hard wired in us. ……. The obstacles to relaxation are what must be overcome to be able to engage our natural ability to profoundly relax. These obstacles centrally involve anxiety, reflex guarding against pain and an upregulated nervous system. The relaxation method we use and have done research on over the years in the Wise-Anderson Protocol,addresses the real-life, moment-to-moment inner obstacles to lying down to do a relaxation session and calm down a nervous system. Over the years we have honed this practice, which we call Extended Paradoxical Relaxation, to help someone who is anxious, chronically clenched and in pain.  Anxiety and chronically tightened core muscles are often-overwhelming and defeating barriers to relaxation.  The goal of our relaxation method is to enable one to enter into a state of profound relaxation. The practice of relaxation can also be  called the practice of conscious effortlessness. In this state the body’s healing mechanisms are called forth.

It takes courage to do learn to deeply relax. To profoundly relax, you are asked to lie down, stay awake, rest your attention in sensation, and allow anxiety, discomfort and protective guarding against pain to come and go as a strategy of moving past them. When you’re anxious or in pain, it’s hard and often scary and unpleasant to lie down for a relaxation session, because it means being alone with your anxiety, discomfort, and uncertainty. Our aversion to these feelings typically sidetracks many people’s attempts to put an end to their anxious state and to enter a state of inner quiet.

Many of our patients have been told to breath deeply or do certain exercises to relax the pelvic floor.  It is my view that such instructions are of little use and usually suggested by someone who is not able to profoundly relax themselves.  There is no quick and dirty way to relax the pelvic floor. Relaxing the pelvis floor and permitting the sore tissue of the pelvic floor to heal by bringing it into an regular environment of daily equanimity is not achieved by a breathing maneuver and can take up to several hours.  Attention must be trained to rest in sensation in an extended period of time, outside of the reach of the discursive, anxious narrative that runs through most people’s minds who are anxious and in pain.

The method we use of Extended Paradoxical Relaxation specifically address what to do with the subtle psychological resistances to lying down with anxiety and discomfort. The method addresses the issue of attention and how central it is to be committed to developing what you can call the ‘muscle’ attention.

When you’re motivated to learn relaxation, you’re often upset emotionally in some way. These feelings are usually unexpressed; they remain inside and are felt as a kind of pressure, anxiety, constriction, or deadness. When unresolved, they are obstacles to your nervous system calming down. Fear, sadness, grief, anger and frustration are among the emotions that may arise. What we train our patient to do with them is critical to learning how to deeply relax.

Anxiety and chronic tension are states of self-defense and concern about survival. When you’re anxious or chronically tense, some deep part of you, usually unspoken, feels like you need to protect yourself. In a kind of unconscious reasoning, some part of your mind believes that tension and anxiety are helping you stay safe. We discuss this in our book as pleasure anxiety, catastrophic thinking, and the desire to avoid disappointment by rejecting the experience of feeling safe.

Pleasure anxiety and the fear of feeling safe and undefended are not just concepts. They are the engine the drives people to compulsive working and workaholism, and we must address them with the aim of overcoming their influence or they remain obstacles to our relaxation.

Extended Paradoxical Relaxation is the Practice of Un-defending Yourself

If tension is part of how you defend yourself, our relaxation protocol is the practice of letting go of defending yourself. When people who are anxious or who suffer from the symptoms associated with pelvic pain and its accompanying anxiety begin to learn relaxation, they usually feel fear about letting go. Sometimes people are uneasy about what they’ll find inside, or afraid that they might lose control, or that something bad will happen if they let down.

Underneath Tension and Anxiety is Peace

I have learned that under all anxiety is peace. It is difficult to discover this on your own.  I had Edmund Jacobson, the father relaxation training in the United States as a teacher. His example and instruction gave me the courage to dare to let go in the way that he taught me.  Underneath suffering, tension, anxiety, and pain, lies serenity. I tell our patients that they only need only trust my words up until they have the experience of this themselves. Then it’s theirs, and they don’t have to rely on what I or anyone else says anymore. When you practice Extended Paradoxical Relaxation in the safety of knowing that someone else has been there, it is far easier to trust that you are safe in resting even when anxiety, fear, sorrow, and uncertainty are present,  because underneath these disturbing emotions is the ease we all want.

What is unconscious controls us. If difficult emotions are not acknowledged during relaxation, they typically remain huge obstacles in entering into the healing state that relaxation provides.

Learning to relax requires a commitment of daily practice. Without real earnestness, reliable ongoing ability to relax in my experience is not possible.

In our protocol, Extended Paradoxical Relaxation is best done in conjunction with loosening the body with trigger point release and its related practices. This combination is found in the practices of types of yoga and meditation that have withstood the test of time over millennia. In the yogic traditions, the body is stretched through the asanas or yoga postures and then meditation is done.  In fact practicing effortlessness – which is commonly called relaxation is both a mental and physical event. Practicing the physical methods of releasing the body’s deep tensions followed by the practice of focusing attention within, in my view is the best way to practice conscious effortlessness in order to provide a healing chamber for the sore pelvic tissue at the heart of pelvic floor pain.

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